D-Rev Applies Silicon Valley Design (and Business) Thinking to the Developing World

“I am not convinced that I would put my child in an incubator that is made of car parts.”

That’s Krista Donaldson speaking. She’s the CEO of Palo Alto, CA-based D-Rev, and the quote says a lot about the non-profit organization and its philosophy on designing healthcare equipment for the developing world.

You may have read about the incubator in question—it’s called NeoNurture, and is the creation of Cambridge, MA-based design studio Design That Matters. The device made a media splash and won design awards last year for its unique solution to the parts shortages that often render medical equipment inoperable in rural hospitals in developing countries. NeoNurture uses car headlights to keep neonatal infants warm, a dashboard fan for air circulation, and a motorcycle battery for backup power. The machine’s designers reasoned that since car parts and car-repair experts can be found almost anywhere, NeoNurture ought to be easier to maintain than a more specialized unit.

But to Donaldson’s way of thinking, the folks at Design that Matters forgot to ask a key question about their device: Could they imagine selling it to a U.S. hospital? “It’s a great example of a product that resonates with the techie community because it very cleverly solves a real need,” says Donaldson. At D-Rev, by contrast, “Our approach is that we are developing world-class products that meet quality standards here, but are designed to meet the needs of the environment there. With every project, we ask, ‘Is this something that could be used at Stanford Hospital? Is this something I would put my children in?'”

D-Rev isn’t building an infant incubator, but it is building a phototherapy device for treating severe jaundice, a condition that afflicts about an eighth of all newborns. And if there’s a simple premise behind that project and the others underway at the four-year-old organization, it’s that patients and healthcare providers in the developing world deserve access to the same high-quality technology available here—and that sometimes all it takes to make such technology affordable is a little Silicon Valley-style design and engineering thinking, matched with on-the-ground market know-how.

Indeed, if you visit D-Rev’s Emerson Street headquarters, just a couple of blocks away from world-famous design consultancy IDEO (where Donaldson once interned), it feels much like any other Palo Alto startup, with the requisite Macs, iPad, and overhead projector. The only sign that D-Rev is developing physical stuff, rather than software, is in the laboratory, where prototypes litter the floor and there’s a workbench complete with circuit boards and soldering irons. And the only sign that D-Rev is a non-profit is…well, there aren’t any.

D-Rev CEO Krista Donaldson shows a prototype for the Brilliance phototherapy device to doctors in India.

“One of the things that makes us a little out of the ordinary, and one of the things that makes us really successful, is that our methods are 95 percent business methods,” says John Dawson, chairman of the board at D-Rev (the name stands for Design Revolution). “It’s not like we are taking just a little bit of Silicon Valley and shoving it into a non-profit. Most of this organization operates like a startup.”

The main difference, Dawson told me when I visited him and Donaldson in Palo Alto in late April, is that D-Rev is aiming for social benefit, not big profits.

“Our currency is impact,” says Donaldson. “We collect minimal royalties on our products, we have licensing deals, but our measure is how successfully we treat children who wouldn’t otherwise receive treatment, and mobilize people who wouldn’t otherwise walk.” (That’s a reference to the JaipurKnee, D-Rev’s multi-axis prosthetic knee joint for amputees.) D-Rev depends on philanthropic grants to fund early product R&D that the market can’t support—the Bill and Melinda Gates Foundation is its largest supporter. But its product development methods are straight out of the for-profit world. And it doesn’t waste time on products that don’t have a market measuring in the millions of people, or for which it can’t find eager manufacturing and marketing partners.

Donaldson is a mechanical engineer who joined D-Rev in 2009 after working as a product designer with KickStart International (then ApproTec) in Kenya, a reconstruction advisor for the State Department in Iraq, and a lecturer at Stanford University. Dawson is a Xerox PARC veteran who helped lead startups such as CASE Technology and Zentek. They’ve been devoting much of their energy over the last year to a product called Brilliance, which uses blue LEDs to deliver phototherapy to babies with severe jaundice. It’s a perfect case study in D-Rev’s methods, which are heavy on customer engagement, rapid prototyping, field testing, and data collection—all standard procedures in the for-profit product development world.

Jaundice is an excess of bilirubin, a breakdown product of red blood cells, in the bloodstream. It’s a common condition in newborns, especially pre-term babies, and usually goes away without treatment. But persistently high levels of bilirubin can cause brain damage, so doctors treat extreme cases with blue light, which breaks down the bilirubin so that it can be excreted.

Commercial “bili lights” aren’t particularly sophisticated, but they’re costly ($3,000 or more), and in places like India, they use blue compact-fluorescent bulbs, which burn out quickly and are difficult and expensive to replace. “We’ve been told that there are no phototherapy units in the whole country of Liberia,” Donaldson says. “Even in India, a fairly wealthy state, 90 percent of clinics will not have effective therapy, because the bulbs are burning out and not being replaced, or they’re being replaced with white bulbs,” which have minimal effect on bilirubin.

After learning about the need, traveling through developing countries and interviewing doctors about their needs was the first step in the creation of the Brilliance system. “There is a long history of not really listening to the customer,” Donaldson says. “You see it even now with these sexy, silver-bullet products. A phototherapy device is not a sexy product, honestly, but it is what the doctors who make purchasing decisions told us they want. They said, ‘We want to have it not break, and we want to be able to afford it.'”

Back in their Palo Alto lab, Donaldson and other D-Rev engineers ran quickly through a series of prototypes—Donaldson calls them “embodiments.” The team gravitated immediately to blue LEDs, which are more efficient than fluorescent bulbs and last far longer. One embodiment was a flexible rubber blanket with strips of LEDs embedded inside. Another was a long tube with LEDs inside, made the same size and shape as a fluorescent bulb so that it could be popped into an existing phototherapy rig.

One of the early "embodiments" of the phototherapy device was a flexible blanket embedded with blue LEDs.

“One of the things we do very well, which is typical of Silicon Valley, is this very rapid prototyping,” says Donaldson. “We’re not just sketching, we’re building things. We’re not worried about it being ugly. On one trip we were cutting up Air Emirates socks on the way to India to use in a prototype eye covering, because the material was so stretchy. We might walk in with four or five ideas and talk to 60 people and ask the same questions four different ways. You have to be careful about asking what people think, because often they won’t tell a nice foreigner that they don’t like something. But they will say ‘Oh, this one is better than that one.’ That’s how we learn about products.”

D-Rev settled on a simple design for Brilliance: a rectangular array of LEDs in replaceable strips of three, with lenses that diffuse the light into a baby-shaped pattern. Donaldson showed me heat maps D-Rev produced using optical modeling software; she called the precise irradiance pattern, plus the low-cost parts, the “secret sauce” of the design. The whole LED assembly is mounted on an adjustable-height stand that can be rolled across a nursery and placed over a bed or bassinet. Even the design of the casters required special attention, says Donaldson: “We learned from talking to users that the casters are often the first things that break, not the lights. In a lot of these environments, a typical cleaning method is to slosh water on the floor, and you don’t want the casters to get clogged up with caked dust.” Now that the basic design is finalized, D-Rev is working with Phoenix Medical Systems, a Chennai, India-based medical equipment maker, to optimize the Brilliance device so that it’s easy and cheap to manufacture.

“Krista has tons of experience with these exact problems,” Dawson says. “Once [a product] gets to a customer, there is still a loop; the feedback you get is really important. We could deliver the thing to some Chinese manufacturer who would make 100,000 of them and give them to an NGO who would distribute them for free, but then there would be no loop at all, nobody who is going to stand up and say, ‘This thing is shitty.'”

Donaldson says that as far as she knows, D-Rev’s licensing deal with Phoenix Medical Systems is the first ever between a U.S. non-profit and a foreign medical equipment maker involving royalties. Phoenix agreed to sell the device for roughly $400, about an eighth the cost of a traditional bili light. That puts the device within reach for typical rural clinics in India, which typically get about $3,000 per clinic per year from state governments for discretionary equipment purchases.

D-Rev will collect minimal royalties on sales in India. But Phoenix also has a non-exclusive right to market the device in other countries, and for units sold to private or high-income hospitals, D-Rev will earn higher royalties. Donaldson says Phoenix has solid distribution channels in Europe, the Middle East, and even Africa—though creditworthiness is a concern for African hospitals. “There are creative ways we can address that, such as microloan guarantees,” says Donaldson. “We will solve the issue.”

True to her original point about quality, Donaldson says the Brilliance design is actually more effective than bili lights made by American manufacturers. And in principle, D-Rev would be happy to see the device distributed in the U.S. But there are a couple of big barriers. One is the intellectual property issue: no U.S. manufacturer will touch a design without the proper patent protections. While D-Rev is pursuing a patent for Brilliance first in India, she says seeking a patent in the United States is a lower priority.

On top of that, advertising and marketing the device in the competitive U.S. sphere would be hugely costly. And under current reimbursement rules, hospitals have few incentives to economize on equipment costs. For all of those reasons, “The U.S. medical market is kind of a sideline for us, just like the developing world is a sideline for U.S. manufacturers,” says Dawson.

The Brilliance phototherapy unit in a clinical setting

Brilliance will be D-Rev’s first product to hit the market, but not far behind is the JaipurKnee, a device already worn by 2,700 amputees as a more stable alternative to traditional prosthetic legs with simple hinge joints; the Global Scope, a low-cost microscope for detecting the microorganisms that cause malaria and tuberculosis; Access for Agriculture, a talking book with flexible programming aimed at improved farming practices; Rise Solar, a solar concentrator that can provide off-grid power to charge cell phone batteries and the like; and an electro-chlorinator that can be used to sterilize the milk transport containers used by dairy farmers in East Africa.

In each case, Donaldson and Dawson emphasize, D-Rev has identified both a need and a demand. Too often, they say, Western designers and engineers get excited about fulfilling a perceived need, without ever bothering to check on whether people actually want the thing they’re building. As Exhibit A they point to Nicholas Negroponte’s One Laptop Per Child project,which has flourished only in a handful of countries where governments have spent millions of dollars to subsidize the machines. The big information technology product transforming the developing world, says Dawson, isn’t the laptop; it’s the cell phone. “Laptops are useless in that context, and you can tell because people won’t pay for them. They have to be given away or they don’t happen,” he says. “But even poor people will pay for access to a cell phone.”

Meeting demand is “the most sustainable way of developing products that lead to impact,” says Donaldson. The questions she says designers should be asking, even if they’re targeting unfamiliar or underdeveloped markets, are “Does this help people earn more money and live a more productive life?” and “Would people here buy it?” If not, they shouldn’t be too surprised when consumers in developing nations also turn up their noses.

Wade Roush is a freelance science and technology journalist and the producer and host of the podcast Soonish. Follow @soonishpodcast

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